Mesh best for hernia repair

Data from nine studies show fewer recurrences than sutures only

Patients who undergo mesh surgery for an abdominal hernia are less likely to experience a hernia recurrence than those who have surgery using sutures only, a review of nine studies finds. Both operations are common among the more than 350,000 abdominal hernia repairs done annually in the United States, but few large studies have compared the techniques.

Abdominal hernias occur when an intestine or other organ protrudes through a weakened section of the muscle wall holding the abdominal organs in place. In mesh surgery, polypropylene webbing is stitched in to patch the repaired site while it heals. In suture-based surgery, the ruptured wall is sewn up.

While 2.7 percent of mesh-surgery patients had a hernia recurrence, the rate was 8.2 percent in the suture-only group, the researchers report February 19 in JAMA Surgery. Mesh surgery was slightly more likely to get infected or to form fluid sacs. The analysis excluded hernia surgeries that arise from past incisions, which are larger than first-time hernias, says coauthor Mike Liang, a surgeon at the University of Texas Health Science Center at Houston. Hernias can also be repaired with laparoscopic “keyhole” incisions, but most surgeons still use the surgeries compared in this study, Liang says.